6 weeks until my Board Exam! Between studying and family visitors, this week has been fun and busy. Wednesday will be my last weekly Physical Diagnosis class at the hospital, and I want to commemorate the occasion by describing this experience, which has been the highlight of my semester.
For the past 14 weeks, each Wednesday I have gotten up at 5:15am to commute to school, then ride a bus 1.5 hours west, and spend a day at a large regional hospital to learn Physical Diagnosis skills. I travelled with 17 other students to participate in interactive lectures, and practice history and exam skills with in-patients at the hospital. The day was organized so we had one hour of lecture, two hours with a patient for a complete history and exam, lunch with another lecturer, and then time to present our patient to a physician and revisit the patient. Each week we were expected to write a complete report and submit it by e-mail for feedback.
I was worried about being exhausted (waking up at 5:15am and commuting 1.5 hours each way), but every Wednesday I’ve felt so excited. Rather than our typical medical lectures, which are focused around organs, these lectures were organized around symptoms, such as “dizziness” and “fever.” My classmates and I were challenged by real patient cases, including one memorable autobiographical story that our favorite physician lecturer shared to introduce the topic of “headaches.” He told a dramatic story about driving to work at the hospital, going 70 mph on the highway, when suddenly he felt a “pop” and experienced the worst headache of his life. He instantly knew the diagnosis, which he described as “the most awesome diagnosis I ever made in my life.”
Any thoughts? That’s how each day began, brainstorming, guessing and creating what is called a “differential diagnosis.” We were encouraged to separate the “common” and “lethal” causes. Along the way, we also learned about physical exam tests, such as the Dix-Hallpike maneuver (an exam to diagnose benign positional vertigo, a type of dizziness). We also sharpened exam skills that we already covered, such as the eye exam.
Most importantly, we had a lot of time devoted to each patient. I introduced myself, taking care to clarify that I am a second year medical student practicing my physical exam skills. I saw patients from 6-months to 86 years-old, in Spanish and English, and suffering from a variety of ailments: a 22 year-old with septic bacteremia (from an infected pimple), a pregnant woman who had been vomiting blood for 2 weeks, a homeless man who had been admitted 22 times in the past year, a diabetic man who confessed he ate a Big Mac and large fries daily, and multiple chronic smokers who had not stopped smoking despite severe COPD (lung damage resulting in less ability for oxygen intake).
Often I felt overcome by gratitude for these patients who were willing to share stories, and let a fledgling examine them. Although I came to medicine because I wanted to serve people, I usually feel that people are serving me. I can only hope that by compassionate attention and listening, I provided some sort of healing service that complimented their care. However, at times I wasn’t sure of this, especially when I was told to wake up patients who seemed exhausted.
I wish there were some way to thank these patients, and convey how much it means to have these experiences. Each new patient who I meet with a certain condition becomes forever engraved in my mind with that illness. They give me a face and meaning, and help the massive amounts of information begin to stick to something more substantial than a pneumonic or acronym.
No doubt this class was my favorite, and also the most valuable learning experience in medical school so far. There were many visible improvements, such as increasing comfort while performing exams and asking questions, less pauses during my oral presentations and less time to type my reports. This weekly experience will soon be my daily experience as I start my 3rd year in a few months, and frankly I cannot wait.
Posted by Liz 
